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$10,000

towards a VEHICLE or

$10,000 in Cash

Must be 18 or older - CARD MUST BE COMPLETED TO BE VALID

  • Name
  • Spouses Name
  • Home Phone
  • Cell Phone
  • Best Time to Call
  • Email
  • HAVE A WATER SOFTENER
  • How Old
  • Marital Status
  • Age Group
  • Combined Yearly Income
  • Homeowner
  • Credit Cards
  • Pet Owner
  • Date Format: MM slash DD slash YYYY